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Reducing Violence and Aggression in A&E by Design Reducing violence and aggression in A&E by design Stephen Platt, William Fawcett, Helen Mulligan, Robin Nicholson and Wen Quek Reference: Platt S, Fawcett W, Mulligan H, Nicholson R, Quek W (2011) Reducing violence and aggression in A&E by design – ‘the Hospitality Hospital’. Presentation to Design Council 14 April Reducing violence and aggression in A&E by design Design Council 14 April 2011 The Hospitality Hospital Cambridge Architectural Research Edward Cullinan Architects Stride Design Audio Analytic Benedict Phillips Jerram Falkus Construction *Flourish/Tsunami Axis hospital? *specialist healthcare furniture providers – or hotel? Reducing violence and aggression in A&E by design The Hospitality Hospital Dr Steve Platt Dr William Fawcett Dr Helen Mulligan – Cambridge Architectural Research Robin Nicholson Wen Quek – Edward Cullinan Architects Reducing violence and aggression in A&E by design The Hospitality Hospital 1. Our approach William Fawcett 2. The design idea – A. Pervasive information William Fawcett – B. Meet & greet Wen Quek – C. Multiple settings Wen Quek 3. Delivering the proof of concept Steve Platt 4. Why choose us Robin Nicholson 1. Our approach: conditions for violence and aggression in A&E departments Experience of People extreme stress Opportunity to Place accost staff 1. Our approach: conditions for violence and aggression in A&E departments Experience of People extreme stress Aggression or violence Incident! Opportunity to Place accost staff Defensive design – to reduce or eliminate opportunities Experience of People extreme stress Aggression or violence Incident! Opportunity to Place accost staff Defensive design Defensive design – to reduce or eliminate opportunities Experience of People extreme stress Aggression or violence Incident! Opportunity to Place accost staff Defensive Responsive design design Defensive design – to reduce or eliminate opportunities Experience of People extreme stress Aggression or violence Incident! Opportunity to Place accost staff eg. Poyner & Fawcett Design for Inherent Defensive Responsive Security (1995) design design Preventative design – to reduce or eliminate extreme stress Preventative design Experience of People extreme stress Aggression or violence Incident! Opportunity to Place accost staff Defensive Responsive design design Preventative design – transforming the user experience Time-line between accident and treatment Accident or emergency Treatment A & E W A I T I N G UNIT ARRIVE CALL FOR TREATMENT AT A&E Preventative design – transforming the user experience Stress level Accident or emergency Treatment A & E W A I T I N G UNIT ARRIVE CALL FOR TREATMENT AT A&E Preventative design – transforming the user experience Stress level * Accident or emergency Treatment A & E W A I T I N G UNIT ARRIVE CALL FOR TREATMENT AT A&E Preventative design – transforming the user experience Stress level * Accident or emergency Treatment A & E W A I T I N G Transform UNIT waiting experience ARRIVE CALL FOR Meet & greet TREATMENT AT A&E 2. The design idea – contrast with current experience ‘Imprisonment’ of ‘Liberation’ of people waiting people waiting A. PERVASIVE INFORMATION transformation Treatment B. MEET & GREET – can’t risk missing your place in the queue C. MULTIPLE Hogarth: Prison scene from SETTINGS The Rake’s Progress (1732) A. Pervasive information MULTIPLE SETTINGS MEET & GREET Treatment W A I T A. Pervasive information MULTIPLE SETTINGS MEET & GREET Treatment W A I T Register smartphone or take mobile number PATIENTS’ DEVICES A. Pervasive information MULTIPLE SETTINGS MEET & GREET Treatment W A I T Register smartphone or free access take mobile terminals number two-way messages PATIENTS’ DEVICES A&E IT HUB A. Pervasive information MULTIPLE SETTINGS MEET & GREET Treatment W A I T Register smartphone or free access take mobile terminals aggression number detection two-way messages PATIENTS’ DEVICES A&E IT HUB A. Pervasive information MULTIPLE SETTINGS MEET & GREET Treatment W A I T Register smartphone or access take mobile terminals aggression number detection two-way a good setting messages could be the patient’s home PATIENTS’ DEVICES A&E IT HUB A. Pervasive information Staff access/ monitoring Portable devices IT system design sketch by Simon Ruffle of Stride Design – Meet & System hub . Uses current technology greet . Upgrade path for future technology . Communicates with remote sites . Can link to hospital’s main IT system, including security systems . Modular elements, site- Security configurable Hospital IT system system . Generates time-series database for management Time-series analysis and policymaking database B. Meet & greet – people are stressed and anxious on arrival Intimidating Friendly Confusing Helpful Alienating Welcoming B. Meet & greet B. Meet & greet B. Meet & greet B. Meet & greet From outside - first impression… B. Meet & greet Once inside – A place to wait… C. Multiple settings – people have control over their environment Variety of Distractions settings C. Multiple settings spaces & activities & distractions 3. Delivering the proof of concept Workstages and timescale Tasks Resources and responsibilities Outputs – the proof of concept Workstages and timescale 4 months May 2011 August 2011 June 2011 July 2011 September 2011 April 2011 October 2011 A. Brief and analysis B. Developing the design C. Implementation and proof of concept Dissemination – Design Council showcase exhibition Roll out * Tasks – A. Brief and Analysis Project management • Programme of work, milestones, responsibilities • Client relationship and communications • Procedures – record keeping, monitoring, approvals Pre-design studies • Visit case study NHS Trust – interviews and observations • Analyse existing research material (including ethnographic studies) • Review best practice in IT/communications for A&E • Feasibility evaluation of design idea with experts Tasks – B. Developing the design Design, brand and ‘kit of parts’ • Set ‘holistic’ context (furniture, materials, colour, lighting) • Develop meet & greet station • Settings for waiting – variety of spaces and possible ‘distractions’ • Work with staff to manage ‘customer relations’ with patients • Define communications protocol for meet & greet • Develop software specification for IT system • Develop hardware specification for IT system • Devise prototype meet & greet digital clipboard • Integrate audio-based aggression detection system Tasks – C. Implementation and proof of concept Applications, mock-ups and presentation • Analyse case study sites and adapt ‘kit of parts’ • Trial working prototype patient communication system • Create virtual reality simulation of design final concept • Mock-up of mobile communications and digital clip-board • Interviews and feedback from staff and patients • Collect statistics and audio evidence about aggressive incidents • Presentation material – videos of key elements of final concept, with staff and patient reactions Resources and responsibilities Cambridge Architectural Research project management and client liaison user research and feedback, integration, exploitation Edward Cullinan Architects architectural design Stride Design IT/communications system Audio Analytic aggression monitoring Benedict Phillips artistic input Jerram Falkus Construction meet & greet station Flourish/Tsunami Axis waiting area – furniture and fittings Plus co-design with case study hospitals, involvement of expert advisors, sub-contracting of presentation materials Outputs – the proof of concept • visualisation of the integrated design idea • non-site-specific design guidance • design studies of guidance applied at two sites • mock-ups of meet & greet and setting for waiting • specification of IT system for communication, resource management and security • mock-up of IT system front end • promotion pack of presentation material • business plan for take-up by investors and roll out 4. Why choose us Our design idea for transforming A&E will deliver: • personalised patient information from home to home • meet and greet, friendly reception and informed patient liaison • freedom from waiting in crowded unpleasant waiting areas • pleasant, well designed welcoming environment • security with a smile • efficient management of A&E resources Leading to … Reduced incidence of aggression and violence Multiple add-on benefits The Hospitality Hospital There are things we can do and things we can influence to make our environment more conducive to reasonable behaviour. … A lot of emergency waiting rooms are dark, dingy, no television, nothing to do and you’re sitting there twiddling your thumbs and getting increasingly stressed out. From my perspective … Bill Bailey, Clinical Director, Emergency Care, Chesterfield Royal Hospital NHS Foundation Trust design can help reduce the – Design Council video incidence of verbal and physical aggression. Reducing violence and aggression in A&E by design The Hospitality Hospital Thank you! hospital? – or hotel?.
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